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Paediatric Neurology Flashcards

1
Q

Name some paediatric neuro pathologies

A

Congenital abnormalities
Neurogenetic diseases and syndromes
Neurometabolic diseases and syndromes
Acquired: Infections, Ischaemia, Trauma, Tumour

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2
Q

Headache disorders affect … % of children by the age of 7, and ….% of children by age 15

A

In about 40% children by age 7, 75% of children by age 15

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3
Q

Clinical evaluation of headache in kids, name the 4 categories of onset

A

Isolated acute
Recurrent acute
Chronic progressive
Chronic non-progressive

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4
Q

Which onsets require a little more investigation? What are you worried about?

A

isolated acute

Chronic progressive

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5
Q

What could an isolated acute headache present with? what type of pain?

A

thunderclap

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6
Q

Chronic non progressive headache is characteristic of …

A

tension type headache

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7
Q

Recurrent or chronic headache history, what to ask?

A

Any warning? - visual disturbance
Location? - all over or font of the head - back of the head - more worrying

Severity? 0-10 - migraine is a 10
tension is less severe and can still go about day
Duration?
Frequency?

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8
Q

Headache examination, what do you do?

A 
Growth parameters, OFC, BP
Sinuses, teeth, visual acuity
Fundoscopy
Visual fields (craniopharyngioma)
Cranial bruit
Focal neurological signs
Cognitive and emotional status
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9
Q

What is the goal of headache examination?

A

To find out if youre dealing with a primary or secondary headache

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10
Q

What is a primary headache?

A

headache with no underlying cause

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11
Q

what is a secondary headache?

A

headache secondary to another cause e.g. tumour

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12
Q

Pointers to childhood migraine

ABDO…

A

abdo pain, nausea, vomiting

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13
Q

Pointers to childhood migraine

Focal symptoms/ signs before, during, after attack:

A

visual disturbance, paresthesia, weakness

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14
Q

Pointers to childhood migraine, SKIN:

A

pallor

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15
Q

Pointers to childhood migraine, aggravated by

A

bright light/ noise

fatigue / stress

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16
Q

Pointers to childhood migraine, helped by

A

sleep/rest.dark, quiet room

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17
Q

Is family history often present in migraine?

A

YES, especially mother

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18
Q

Pointers to childhood migraine

what is the pain like?

A

Hemicranial, throbbing/pulsatile

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19
Q

How is tension type headache different to migraine?

A

Tends to be featureless headache - non specific - almost present all the time and never goes away

TTH - diffuse, symmetrical
Band-like distribution
present most
Constant ache

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20
Q

Pointers to

Raised intracranial pressure are…

A

Aggravated by activities that raise ICP e.g. Coughing, straining at stool, bending
Woken from sleep with headache +/- vomiting

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21
Q

Pointers to analgesic overuse headache

A

Headache is back before allowed to use another dose
Paracetamol / NSAIDs
Particular problem with compound analgesics e.g. Cocodamol

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22
Q

Indications for neuroimaging in headache paeds

A 
Features of cerebellar dysfunction
Features of raised ICP
New focal neurological deficit e.g. new squint 
Seizures , esp focal
Personality change
Unexplained deterioration of school work
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23
Q

management of migraine -Acute Attack - includes..

A

effective pain relief

triptans

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24
Q

If more than 1 episode of migraine per week need to think preventative medication which include…

A

Propranolol B blocker

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25
Aim of reassurance when managing Tension type headache is to explain...
that there is no sinister cause
26
Tension type headache management of acute attacks
simple analgesia
27
Prevention of tension type headache
amitryptiline
28
Other things to consider in tension type headache mamagement
MDT management Attentions to underlying chronic physical, psychological or emotional problems Discourage analgesics in chronic TTH
29
What is a seizure/ fit?
Any sudden attack from whatever cause
30
Syncope is
a faint (a neuro-cardiogenic mechanism)
31
What is a convulsion?
Seizure where there is prominent motor activity
32
many seizures are not ...... in nature
epileptic
33
An epileptic seizure is an ..... phenomenon
electrical
34
Definition of an epileptic seizure
An abnormal excessive hyper synchronous discharge from a group of (cortical) neurons
35
What is epilepsy?
tendency to recurrent, unprovoked (spontaneous) epileptic seizures
36
Acute symptomatic seizures: due to acute insults e.g....
Hypoxia-ischaemia, hypoglycaemia, infection, trauma
37
Reflex anoxic seizure
common in toddlers | is provoked e.g. bump to the head
38
parasomnias
abnormal movements and stuff e.g. night terrors
39
Behavioural stereotypies
funny movement of younger kids
40
Psychogenic non-epileptic seizures (PNES)
epileptic seizure without the electrical activity - psychological in origin
41
Acute symptomatic seizure commonest cause :- Febrile convulsion which is....?
seizure occurring in infancy/childhood, 3months - 5 years associated with fever but without evidence of intracranial infection or defined cause for seizure
42
Is Febrile convulsion common in childhood?
YASS BITCH
43
which type of seizure involve a jerk/ shake?
clonic, myoclonic, spasms
44
which type of seizure involve going stiff?
usually a tonic seizure
45
which type of seizure involve a fall?
Atonic / tonic / myoclonic
46
which type of seizure involve a vacant attack?
absence, complex partial seizure
47
Epileptic fits are chemically triggered by..
``` decreased inhibition (gama-camino-butyric acid, GABA) Excessive excitation (glutamate and aspartate) Excessive influx of Na and Ca ions ```
48
epileptic fits can be recorded through surface electrodes by .... because....
electroencephalogram (EEG) because Chemical stimulation produces an electrical current Summation of a multitude of electrical potentials results in depolarization of many neurons which can lead to seizures
49
Types of Epileptic Seizures
partial seizure | generalised seizure
50
stepwise approach to diagnosis of epilepsy
is the paroxysmal event epileptic in nature? Is it epilepsy? What seizure types are occurring? What is the epilepsy syndrome? What is the biology? What are the social and educational effects on the child?
51
Helpfullness of EEG
identifying seizure types, seizure syndrome and aetiology
52
How to diagnose epilepsy
History Video ECG in convulsive seizures Interictal/ octal EEG MRI brain: to determine aetiology e.g. malformations/ brain damage Genetics: idiopathic epilepsies are mostly familial; also single gene disorders e.g. Tuberous sclerosis metabolic tests:es if associated with developmental delay/ regression
53
What drugs for epilepsy?
Anti-epileptic drugs (AED) should only be considered if diagnosis is clear even if this means delaying treatment
54
Does AED cure epilepsy?
No just controls seizures
55
What factors should be considered when selecting AEDs?
Age, gender, type of seizures and epilepsy
56
Side effects of AEDs
CNS related can be detrimental; Drowsiness, effect on learning, cognition and behavioural
57
first line drug treatment for generalised epilepsies...
Sodium Valproate or Levetiracetam
58
Carbamazepine is first line for
focal epilepsies
59
Other therapies for epilepsies
steroids, immunoglobulins and ketogenic diet Vagal nerve stimulation Epilepsy surgery
60
What is a fontanelle?
soft membranous gaps (sutures) between the cranial bones
61
Microcephaly definition mild... and moderate/ severe.....
OFC < 2SD OFC <3 SD
62
macrocephaly definition
OFC > 2SD
63
Pagiocephaly is
flat head
64
Brachycephaly
short head or flat at back
65
Scaphocephaly
boat shaped skull
66
Craniosynostosis
brain sutures close too early
67
When to suspect a Neuromuscular disorder...
``` baby floppy from birth Slips from hands paucity of limb movements Alert, but less motor activity Delayed motor milestones Able to walk but frequent falls ```
68
classical sign of Duchenne's muscular dystrophy
Gowers sign

Paediatrics (15 decks)

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